In a full assessment for NHS Continuing Healthcare 12 care ‘domains’ are assessed. These domains are essentially different aspects of health – and each is given a score. The combined score from all 12 domains determines whether or not someone is granted full NHS funding to cover all care fees.
However, many assessments look at only 11 domains, and the 12th is overlooked.
NHS Continuing Healthcare is the full NHS funding that covers 100% of care fees for someone needing full time care primarily for health reasons.
Continuing Care domains
The assessed domains include: 1) Behaviour; 2) Cognition; 3) Psychological/Emotional Needs; 4) Communication; 5) Mobility; 6) Nutrition; 7) Continence; 8) Skin Integrity; 9) Breathing; 10) Drugs/Symptom Control; 11) Altered States of Consciousness… and 12) ‘Other’.
It’s this 12th ‘Other’ domain that almost always gets forgotten or overlooked by assessors, and yet for the person being assessed it can sometimes make the difference between securing full funding or not. And without full funding you’re at risk of losing your home to pay for care.
The guidelines state that the Other domain should be used to record health and care needs that don’t fall into the 11 preceding categories. Most Continuing Care assessment notes are hand-written – however, this does not mean that assessors can simply use the page labelled ‘Other’ at the back of the assessment notes as additional space for notes that couldn’t be squeezed into the previous pages. The health needs recorded in the Other domain should be considered carefully and given a legitimate score that counts towards the final outcome. This score could be Low, Moderate, High or Severe – and a score of High or Severe in particular in this 12th domain can tip the balance into eligibility for full funding.
There are no set criteria for the scoring in this domain and the interpretation of it is wholly subjective on the part of NHS assessors. That’s why it’s vital for families to be alert to its existence and to put forward any evidence of health and care needs that fit into this domain.
‘Other’ health needs
Needs could include things like fluctuations in blood pressure, cardiac problems, diabetes and blood sugar issues (poorly accounted for in the Nutrition domain), some skin problems unrelated to pressure sores, extreme fatigue and severely disturbed sleep, oral hygiene, brittle/yellowing nails and associated deficiencies or infections, anaemia, nosebleeds, risk of attack from other people in care, temperature/fever, poor immune system and susceptibility to infection, problems with eye health, vomiting, dizziness and nausea, cholesterol issues, difficulties taking blood samples, whether someone is on the Liverpool (end of life) Care Pathway and should be fast tracked for funding – anything that has not been included elsewhere in the assessment notes and adds weight to your case for funding
So always check that 12 (not 11) domains have been assessed and completed in any full assessment for Continuing Care funding.